Adolescence begins with the onset of physiologically normal puberty, and ends when an adult identity and behavior are accepted. This period of development corresponds roughly to the period between the ages of 10 and 19 years, which is consistent with the World Health Organization’s definition of adolescence.

Adolescents constitute about 23 percent of the total population in Bangladesh. The current number of adolescents in Bangladesh is about 3o millions (Adolescent Strategy Paper 2006, DGFP and UNFPA).

Adolescent Sexual and Reproductive Health and Rights situation in Bangladesh has been recognized officially as ‘unsatisfactory' both in terms of program efforts and actual performance. It has been recognized as one of the major health and development challenges.

Though the legal age of marriage is 18 years, more than 50% of women in the 15-19 age groups are married. Adolescent fertility is estimated at 135/1000 where 60% adolescent have their first child before the age of 19. At the age of 16, about 17 percent girls are already mothers and 6.2 percent are currently pregnant. Pregnant adolescents are a very high risk group and more vulnerable to complications (117 births per 1000 women aged 15-19).

Objectives ..........
The objectives of the program is –

• To increase the knowledge and create awareness among the adolescents on sexual, reproductive, health and nutrition issues through providing information and counseling.
• To increase awareness among community on ASRH issues.
• To increase the utilization of ASRH services by adolescents through expanded RHSTEP clinics.

Programs ..........
To address the sexual and reproductive health rights (SRHR) of adolescents, RHSTEP started ‘Adolescent Health Care Program’ on May 2003. The Maternity Clinic (MCD) of RHSTEP first started the ARH program on 17 May 2003 at Pallabi Mazedul Model High School, Pallabi, Dhaka on Food & nutrition issue. After that RHSTEP undertaken a number of pragmatic feasible initiatives through its 35 service centers situated in 20 districts.

The programs are rendering in four levels -
..........
a. Clinic level
b. School and Madrasa level
c. Garments level, and
d. Community level.

Clinic level

• Counseling on ASRH.
• Provision of nutritional supplementation for girls adolescent.
• Medicare services especially for reproductive health related problems including RTI/STI and gynecological problems.
• Referral for any health related complications.
• Awareness creation through group discussion session on SRHR issues.
• Disseminate messages through cultural program.
• Observance of national, international days/events.
  

School and Madrasa level

• Health education sessions on general, sexual and reproductive health and nutrition issues.
• Medicare services like primary health care, management of RTI/STIs, nutritional supplementation, immunization and blood grouping through organizing satellite clinics
• Adolescents fair
• Orientation program for adolescents gatekeepers

Garments level
..........
RHSTEP Maternity Clinic of Dhaka (MCD) is particularly assigned for this program.

• Health education on SRHR issues
• Peer education
• Medicare services like management of RTI/STI/STD
• Sharing meeting with garments owner and other stakeholders

Community level

• ..Health education session on general health, sexual and reproductive health and nutrition issues at different clubs and communities.
• Special BCC program at community through IPC and group meetings at local clubs or community centers
• Medicare services like primary health care, nutritional supplementation immunization and blood grouping through organizing satellite clinics at communities
• Discussion meeting with different stakeholder of the community
• Community fair
• Meeting with parents (gatekeepers)

Under this program, RHSTEP covered 19 garments in Dhaka, 55 numbers of schools and 53 numbers of communities in different districts of Bangladesh. Besides, 23 Peer Educators in garments and 6 in school are being formed in Dhaka. The garments peer educators are already got the training on peer education and life skills.

A total of 143,599 adolescents including boys and girls received services in July 2007 to June 2008. And a total of 43,920 garment workers and 54,913 community people including adolescents were reached with medical support as well as education in this period.

The program is highly accepted to the beneficiaries, gatekeepers and others and that they endorsed through their some statements as mentioned below:

Nikita, Sampa and Tumpa, students of class 8, Bashbari Girls High School, Mohammadpur, Dhaka said-

“We learnt a lot through participating in the education program that we never dare to ask anyone even not to our friends or parents. We even openly discussed with the doctors and counselors about different problems at adolescent period.

They never stopped us asking any question rather they encouraged us to learn more and more. We are really grateful. We think there should be a friendly environment for the adolescent in our society to share their problems and to get the necessary suggestions.”



Jahangir Alam, Peer Educator in garments (Apollo Printing) said -

“I wanted to serve people. Finally, my dream was come true. Last November 2007 I became peer educator and received the training. It was really a wonderful experience. I learned about importance of reproductive parts of our body.
Now I am telling the same things to the garments worker in my work place. I advise the adolescent not to marry before 18 and not to be a mother before 20. I even tell the workers on different sexually transmitted diseases and advised them to get protected from diseases.”

Mrs. Salma Banu, Parents expressed her opinion -

“As mother of a daughter I was always concerned about her health. But, yes there is always a gap between us despite of my all efforts. The age and the culture of our society may be the reason behind the matter. But, we have to look at our adolescents as they are the future of the country.

So, we should create a space for them where they can share their question and problem more easily and lively. The education on adolescent issue has taken that kind of initiative to create the open space for them. And from that knowledge I believe they will learn to maintain a sound health and be bold for the course of life.”

Mohammad Harunur Rashid Patwari, Headmaster, Rupnagar Adarsha School, Rupnagar, Pallabi, Dhaka said -

“RHSTEP’s this education program in school is really appreciable. This program is playing a supportive role improving student’s physical and mental health.

They are being benefited through the education. I wish this program will remain continue in this school and will be expanded day by day. This is a very good initiative for making a healthy nation.”

Dr. Md. Rabiul Islam, Consultant, Gynea, Jessore General Hospital said-

“RHSTEP’s ‘Adolescent Health Care Program is important in various aspects. Major portion adolescent girls in our country face lots of trouble. They even cannot speak out their problem due to shyness.

This school and community based program is trying to make aware these adolescent groups through providing education. Besides, the poor adolescents are being facilitated by free medicine and treatment service that has become great support to them.”

Hasan Sarowar, Technical Director, Apollo Printing – 1, Mirpur, Dhaka said-

“The reproductive ‘health and rights’ is a very important issue today. Because, most of the people don’t know about his/her health rights especially the women are in a very risky condition in this regard. They even can’t take the decision about the size and space of her children. RHSTEP has been providing that types of services in our factory for long four years.

Our workers are now doing their work very comfortably as they now relaxed about their health issue. I can say proudly that we have had RHSTEP close to us the moments when we really felt needs. I consider RHSTEP as a part of Apollo Printing. I hope RHSTEP will remain close to us as long as Apollo Printing will exist.”

Identified health problems of adolescents:
..........
The adolescents has different social and health related problems that needs to be addressed and solved accordingly. On this basis, RHSTEP has listed the following problems during this year (July 2007 – June 2008),

• Dysmenorrhoea
• Irregular Menstruation
• Fever & cold cough
• Itching
• Scabies
• General weakness
• Anemia
• Headache
• Acidity
• White discharges
• Amenorrhea
• Migraine
• Loss of eye sight
• Diarrhoea etc.

Topics for BCC programs
..........
To bring changes in the knowledge and practices of targeted adolescents RHSTEP initiated ‘Behavior Change Communication’ activities at the project area. The BCC activities are being delivered on the following topics to create awareness on adolesent sexual and reproductive health and rights among the beneficiaries-

• Puberty
• Menstruation
• Personal Hygiene
• Food and Nutrition
• RTI/STI/HIV/AIDS/Hepatitis-B
• Demerits of early marriage
• Prevention of dowry
• Sexual and Reproductive Health and Rights
• Violence Against Women and importance of women’s self reliant
• Family Planning
• Menstrual Regulation (MR)
• Importance of Breast Feeding
• Importance of Blood Grouping

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